Introduction: Paraneoplastic syndromes (PNS) have infrequently been reported in patients with Hodgkins Lymphoma (HL). We describe here the clinical characteristics and outcomes of patients with HL with PNS treated at our center
Methods: This was a retrospective analysis conducted at a tertiary care center in India. All patients with HL with PNS treated at our center between January, 2018 and March, 2023 were included in the study. Details regarding the demographics, disease characteristics, PNS, treatment characteristics as well as outcomes were noted. An Event was defined as progression or relapse or death due to any cause. Follow-up was censored at 31st March, 2024
Results: Three-hundred ten patients with newly diagnosed HL were treated at our center during the study period of whom, 29 patients (9.3%) had PNS. The majority of patients were male (n=18, 62.1%) with a median age of 29 years (IQR 20-36.5). Twenty-three patients (79.3%) had advanced stage disease, while 5 patients (17.2%) and 1 patient (3.4%) had early unfavorable and early favorable disease respectively. The most common PNS was pruritis (n= 9; 31.1%) followed by hematological manifestations (not due to marrow infiltration) (n= 8; 27.6%). Amongst the hematological manifestations, 3 patients had Immune thrombocytopenia, 2 patients had autoimmune hemolytic anemia, 2 patients had Hemophagocytic Lympho-Histiocytosis and 1 patient had Aplastic Anemia. The details of the PNS are given in Table 1. The majority of patients had a concurrent diagnosis of the PNS and HL (n= 25; 86.2%) and 2 patients each had a diagnosis of PNS before and after the diagnosis of HL respectively.
Twenty-one patients (72.4%) received ABVD therapy initially, 4 patients received COPP, 1 patient received GDP, while 2 patients could not get definitive therapy due to PNS and 1 patient opted against any therapy. Twenty-one patients completed therapy and 16 patients (76.2%) achieved a complete response. Six patients had refractory disease (23.1%) and 2 patients relapsed after achieving remission. The median follow-up for the cohort was 28 months (IQR 16.5-45). Nine patients (31%) died during follow-up, with the most common cause of death being disease related. The median Event Free Survival was 39 months while the median Overall Survival was not reached.
Conclusion: PNS can have a diverse presentation in patients with HL. Treatment can be a challenge given the different organ involvement which may prohibit use of different agents
Charanpreet Singh, Lekshmon K S, Arihant Jain, Alka Khadwal, Amanjit Bal, Radhika Srinivasan, Rajender K Basher, Pankaj Malhotra, Gaurav Prakash